- Many Americans aged 60 and older still take aspirin as primary prevention of cardiovascular disease, even though guidelines have changed.
- Aspirin may increase the risk of bleeding and anemia and is not suitable for everyone.
- Over the past five years, recommendations regarding aspirin and primary prevention of cardiovascular disease have changed, but many Americans still seem unaware.
Older adults are still likely to take a low dose of aspirin daily for primary prevention of cardiovascular disease, although this carries significant risks.
Using aspirin to prevent heart attacks and strokes used to be a no-brainer. Doctors had already recommended it for both
However, following the results of three major clinical trials of aspirin in 2018, recommendations for aspirin have changed. It is no longer generally recommended for people who have not had a heart attack or stroke. However, it is still recommended for patients who have already had a cardiovascular event and are trying to prevent another one.
Aspirin is no longer generally recommended because of its potential risks, including
The American Heart Association and the U.S. Preventive Services Task Force have both changed their guidelines in recent years to say that aspirin is not appropriate for all patients and carries risks. Despite these changes, new data reveal that many Americans who should not take aspirin daily are still doing so, especially those at highest risk.
In a research letter published in the Annals of Internal Medicine, researchers found that 18.5 million Americans aged 60 or older, or about one in three, were still using aspirin for primary prevention of cardiovascular disease. Many of them, about 3.3 million, were doing so without medical advice.
“This practice was supported by evidence prior to 2018. It naturally takes time for new data to filter through and reach physicians and patients and translate into changes in management. Potentially, there may also be a component of lack of awareness and hesitancy to change medical management,” Mohak Gupta, MD, a cardiology researcher at Houston Methodist Hospital and first author of the letter, told Healthline.
Gupta’s research used self-reported health data between 2012 and 2021. The sample of 186,425 U.S. adults is a snapshot of the U.S. population, representing about 150 million people. More than half of the participants were women and about a third were nonwhite.
Compared with a decade ago, fewer adults are using aspirin for primary prevention of cardiovascular disease, but this figure remains high. The number of adults without cardiovascular disease who reported using aspirin was 14.4%, compared to 20.6% in 2021.
However, if we classify people by age, we get a different picture: among adults aged 70 and older, 38% still use aspirin. This figure is important because the risk of bleeding increases with age.
“Elderly people are the most vulnerable because they have a higher risk of bleeding. They are taking more medications, which can lead to more drug interactions with aspirin, which can lead to an increased risk of bleeding,” Dr. Parul M. Goyal, associate professor of medicine and director of the Medicine for the Elderly at Vanderbilt University Medical Center, which was not affiliated with the study.
The study authors write that their findings have real-world implications: Despite changing regulations, there is a disparity or lack of knowledge about these changes among patients, particularly older ones. Patients and health care providers need to have meaningful conversations about the risks and benefits of daily aspirin use.
“Physicians should engage in risk-benefit discussions with patients using aspirin for primary prevention, particularly in adults 60 years of age and older, and discontinue aspirin when appropriate, such as in older patients or those at high bleeding risk,” Gupta said.
Three studies in 2018 represented a seismic shift in the perception of aspirin for primary prevention of cardiovascular disease. These studies, the ASCEND trial, the ASPREE trial and
In 2019, the American Heart Association released an update
Three years later, in 2022, the U.S. Preventive Services Task Force updated its own
“The USPSTF recommends against initiation of low-dose aspirin use for the primary prevention of cardiovascular disease in adults 60 years of age or older,” the statement said.
“When we talk about primary prevention patients, there is a little more risk-benefit consideration. Are we more likely to prevent the first heart attack or stroke, or are we more likely to cause a major bleeding episode by using aspirin? Donald Lloyd-Jones, MD, past president of the American Heart Association and professor of preventive medicine at Northwestern University’s Feinberg School of Medicine, told Healthline.
“In secondary prevention, it is very clear: you have to take aspirin, period,” he added.
Aspirin is an anticoagulant, meaning it has anticoagulant or antiplatelet properties that prevent blood from clotting. These properties are helpful in preventing heart attacks and strokes, but can lead to other health problems, including an increased risk of bleeding.
“The bleeding events that led to the guideline change were all types of bleeding. They could be falls and blows to the head, but they were mostly spontaneous bleeding in the stomach,” Dr. Eleanor Levin, clinical professor of cardiovascular medicine at Stanford Medicine, told Healthline.
For older adults, falls can be a serious health problem. When combined with an increased risk of bleeding from aspirin, you have a potentially deadly mix.
“You have to consider again, in older people at risk for falls, head trauma and increased intracranial hemorrhage, that if they haven’t had a stroke before, you are putting them at risk for bleeding.” , Levin said.
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Experts contacted by Healthline said patients and doctors should have an informed conversation about the risks and benefits of taking aspirin for primary prevention of cardiovascular disease.
Lloyd-Jones also warned that if you have been taking aspirin, even if you do so without medical advice, you should consult a doctor before stopping. It can lead to
“This document should not encourage anyone to stop taking any medication. Instead, it should encourage people to talk to their doctors about why they are taking aspirin,” he said.
Many older Americans continue to take a low dose of aspirin daily for primary prevention of cardiovascular disease, even though it may put them at increased risk of bleeding.
Over the past five years, recommendations have changed regarding taking aspirin to prevent cardiovascular disease in people who have never had a heart attack or stroke before.
Experts say patients should have a detailed conversation about the risks and benefits of taking aspirin as primary prevention for cardiovascular disease to determine whether they would be a good candidate.